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Suspected peritonsillar abscess in children
Kelly R Millar1, David W Johnson, Derek Drummond
1Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. Kelly.Millar@CalgaryHealthRegion.ca
Insights
Peritonsillar abscess (PTA) is most common in adolescents. Most children with suspected PTA can be treated as outpatients without adverse outcomes, and corticosteroid use showed no clear benefit.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
Background:
- Peritonsillar abscess (PTA) is a common complication of tonsillitis in children.
- Understanding the epidemiology and management of PTA in pediatric populations is crucial for optimizing patient care.
Purpose of the Study:
- To describe the demographics and clinical course of pediatric peritonsillar abscess (PTA).
- To determine the incidence of suspected and confirmed PTA in children.
- To examine factors influencing corticosteroid use and outpatient management of suspected PTA.
Main Methods:
- Population-based, retrospective chart review of children diagnosed with PTA in the Calgary Health Region (CHR) from March 1994 to December 2001.
- Inclusion criteria: age <18 years, CHR resident, diagnosed with PTA (ICD-9 475).
Main Results:
- 229 children experienced 249 episodes of suspected PTA; incidence was 14/100,000 person-years, highest in adolescents (40/100,000).
- Confirmed PTA incidence was 3/100,000 person-years.
- 69% of patients were managed as outpatients, with 8% requiring subsequent admission; 37% received corticosteroids without clear benefit or harm.
Conclusions:
- Peritonsillar abscess predominantly affects adolescents but can occur in younger children.
- Outpatient management is safe and effective for the majority of pediatric PTA cases.
- Corticosteroid use in pediatric PTA is common but lacks demonstrated efficacy or adverse effects.
Objectives:
(1) To describe the demographic features and clinical course of children diagnosed with suspected peritonsillar abscess (PTA), (2) to determine the incidence of suspected and confirmed PTA in children younger than 18 years, and (3) to examine the factors associated with corticosteroid use and outpatient management of suspected PTA.
Methods:
We conducted a population-based, retrospective chart review. The study was conducted within the Calgary Health Region (CHR). Patients met inclusion criteria if they were younger than 18 years, resided in the CHR, and were diagnosed with PTA (International Classification of Diseases, Ninth Revision 475) in the CHR between March 1994 and December 2001.
Results:
We identified 229 children (cases) who presented with 249 unique episodes of suspected PTA. The incidence of suspected PTA among children in the CHR was 14 cases per 100,000 person-years at risk. The incidence was highest among adolescents (40 cases per 100,000 person-years). The incidence of confirmed PTA was 3 cases per 100,000 person-years at risk. Among those with suspected PTA, surgical intervention, intravenous antibiotics, and corticosteroids were provided to 34%, 87%, and 37%, respectively. One hundred fifty-seven patients (69%) were initially managed as outpatients. Of these, 12 (8%) had subsequent uncomplicated hospital admissions.
Conclusions:
Peritonsillar abscess is primarily a problem of adolescence, but the disease does occur in young children. Corticosteroid use was common but without either clear benefit or adverse outcomes. Two thirds of patients were managed as outpatients without any apparent increase in adverse outcomes.
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